Making it Easier for Kids to Enroll in PCIP

Under the Affordable Care Act, it has become much easier for parents to get their children the health coverage they need and deserve. New guidance issued today will make it even easier for children to get coverage through one of those new options – the Pre-existing Condition Insurance Plan (PCIP).

Under the policy announced today, children can still qualify through the existing eligibility pathway –by showing that they have been offered coverage at twice the standard market rate. The guidance also clarifies that, in the states with a federally-administered PCIP program, there is an additional way to qualify. A child can qualify with a document from a health care provider stating that the child has or used to have a pre-existing condition, as defined in the Public Health Service (PHS) Act. The PHS Act defines a “pre-existing condition” as a condition present before the date of enrollment for health insurance coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date.

Today’s guidance only applies to federally-administered PCIP program. You can learn whether your state is in the federal program here. In states that administer their own PCIP programs, families should check with their specific program, and that information is also available here.

Also, it does not does not change other rules related to PCIP eligibility. To qualify for the program, a child must be a citizen or national of the United States and must have been uninsured for at least the last 6 months.